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Mechanical heart valve cavitation in patients with bileaflet valves

机译：双叶阀患者机械心阀空化

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Today, the quality of mechanical heart valves is quite high, and implantation has become a routine clinical procedure with a low operative mortality (< 5%). However, patients still face the risks of blood cell damage, thromboembolic events, and material failure of the prosthetic device. One mechanism found to be a possible contributor to these adverse effects is cavitation. In vitro, cavitation has been directly demonstrated by visualization and indirectly in vivo by registering of high frequency pressure fluctuations (HFPF). Tilting disc valves are thought of having higher cavitation potential than bileaflet valves due to higher closing velocities. However, the thromboembolic potential seems to be the same. Further studies are therefore needed to investigate the cavitation potential of bileaflet valves in vivo. The post processing of HFPF have shown difficulties when applied on bileaflet vavles due to asynchronous closure of the two leaflets. The aim of this study was therefore to isolate the pressure signature from each leaflet closure and perform cavitation analyses on each component. Six patients were included in the study (St. Jude Medical (n=3) and CarboMedics (n=3); all aortic bileaflet mechanical heart valves). HFPFs were recorded intraoperatively through a hydrophone at the aortic root. The pressure signature relating to the first and second leaflet closure was isolated and cavitation parameters were calculated (RMS after 50 kHz highpass filtering and signal energy). Data were averaged over 30 heart cycles. For all patients both the RMS value and signal energy of the second leaflet closure were higher than for the first leaflet closure. This indicates that the second leaflet closure is most prone to cause cavitation. Therefore, quantifying cavitation based on the HFPF related to the second leaflet closure may suggest that the cavitation potential for bileaflet valves in vivo may be higher than previous studies have suggested.
机译：如今，机械心脏瓣膜的质量很高，植入已成为常规临床程序，具有低手术死亡率（<5％）。然而，患者仍然面临血细胞损伤，血栓栓塞事件和假肢装置的材料失效的风险。发现有一个机制是这些不利影响可能的贡献者是空化。体外，通过可视化并通过注册高频压力波动（HFPF）来直接通过可视化和间接地证明空化。由于更高的闭合速度，倾斜盘阀被认为具有比双叶阀更高的空化电位。然而，血栓栓塞潜力似乎是一样的。因此需要进一步的研究来研究体内双叶阀的空化电位。由于两只小叶的异步关闭，HFPF的后处理已经施加在双方浮动时施加困难。因此，本研究的目的是将来自每个宣传叶闭合的压力签名分离，并在每个组分上执行空化分析。六名患者被列入研究（圣裘德医疗（N = 3）和碳（n = 3）;所有主动脉双面机械心阀）。通过主动脉根的水听器术中记录HFPF。与第一和第二传单闭合有关的压力签名被隔离，计算空化参数（50kHz高通滤波后RMS和信号能量）。数据平均超过30个心脏周期。对于所有患者，第二传单闭合的RMS值和信号能量都高于第一传单闭合。这表明第二传单闭合最容易导致空化。因此，基于与第二宣传件封闭件相关的HFPF的量化空化可以表明体内体内平衡阀的空化电位可能高于先前的研究表明。

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